PERIPHERAL VASCULAR DISEASE AFTER PANCREAS TRANSPLANT

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668 The role of Ptx in altering the course of peripheral vascular disease (PVD) is uncertain. We evaluated a cohort of PTx recipients to determine the risk factors for peripheral vascular disease progression or complications after PTx. A retrospective review of all PTx performed from 1990 to 1997 was performed. Exclusions were made for graft or patient survival less than one year. Charts were reviewed for the presence of coronary artery disease (CAD), hypertension (HTN), hyperlipidemia, alcohol or tobacco use, duration of diabetes and dialysis. Post-Ptx variables evaluated include length of graft and patient survival, yearly cholesterol, LDL, HDL, and triglyceride levels. Annual non-invasive lower extremity vascular studies were obtained in most and evaluated for progression of PVD (worsening of pulse volume recordings or ABI reduction). Outcome was evaluated by pro-gression of PVD on non-invasive testing, amputation, or revascularization. Data is presented as mean±SEM. A p value ≤ 0.05 was considered significant. 62 patients, age 37.3±1 years, duration of diabetes 23.8±1 years were included. Forty one (66%) patients were males, 50 patients (80.6%) were on dialysis for 13.9±2 months. Pre-PTx HTN, hyperlipidemia, CVA, CAD, amputations and vascular reconstructions were identified in 57 (91.9%), 17 (27.4%), 2 (3.2%), 14 (22.6%), 6(9.7%) and 2(3.2%) patients respectively. 14 patients(22.6%) required amputation, 9(14.5%) underwent bypass and 19(30.6%) had PVD progression on vascular studies post-PTx. LDL at one year was higher in those with PVD progression 144.9±9 vs. 116.1±7 mg/dl (p=0.017), in patients requiring amputation 153.7±14 vs. 121.2±6 mg/dl(p=0.033) and in those requiring bypass 165±16 vs. 120.4±5 mg/dl(p=0.005). Cholesterol at one year was elevated in those wth PVD progression and those undergoing post-PTx bypass 221.9±12 vs. 187.7±7 mg/dl (p=0.017) and 232.3±23 vs. 194.7±7 mg/dl(p=0.048) respectively. One year triglyceride levels were elevated in PTx patients with PVD progression and in those requiring bypass 156.6±22 vs. 101.9±11 (p=0.022) and 175.5±48 vs. 112.3±10 (p=0.046) respectively. Multiple regression analysis identified only pre-PTx CVA (p=0.011) and CAD (p=0.006) as predictive of post-PTx PVD progression. No variables were found predictive of post-PTx bypass or amputation. Pre-PTx CAD and CVA were found to identify recipients at increased risk for progression of PVD. Improved control of hyperlipidemia may provide a therapeutic strategy for altering the progression of PVD in this population.